Patients with Unstable Angina Should NOT Fly
A patient with unstable angina should not undertake commercial air travel, and therefore the question of using a portable oxygen concentrator is moot—the flight itself is contraindicated regardless of oxygen availability.
Why Flying is Contraindicated in Unstable Angina
The ACC/AHA guidelines explicitly state that air travel within the first 2 weeks of myocardial infarction should only be undertaken if there is no angina, dyspnea, or hypoxemia at rest 1. Unstable angina represents an acute coronary syndrome with active myocardial ischemia, making it an even higher-risk condition than a stabilized post-MI patient.
Physiological Stressors of Air Travel
Commercial aircraft are pressurized to cabin altitudes of 7,500-8,000 feet (2,438 meters), which creates several cardiovascular stressors 1:
- Reduced oxygen availability: At 8,000 feet cabin altitude, the inspired oxygen is equivalent to breathing 15.1% oxygen at sea level, causing PaO2 to fall to 7.0-8.5 kPa (53-64 mm Hg) even in healthy individuals 1
- Increased cardiac demand: The hypoxic environment increases myocardial oxygen demand precisely when oxygen delivery is compromised 1
- Physical exertion: Walking through airports, carrying luggage, and boarding creates additional cardiac stress that can precipitate ischemia 1
When Cardiac Patients Can Safely Fly
The ACC/AHA guidelines provide clear criteria for when cardiac patients may travel 1:
- Stable angina patients who have been revascularized may fly within days of the procedure 1
- Post-MI patients without complications (no CPR, hypotension, serious arrhythmias, high-degree block, or heart failure) can fly 1 week after discharge if they have no angina, dyspnea, or hypoxemia at rest 1
- Complicated MI patients should delay flying 2-3 weeks after symptom resolution 1
Essential Requirements for Any Cardiac Patient Flying
If a cardiac patient meets stability criteria, they must 1:
- Have a companion during travel
- Carry nitroglycerin
- Request airport transportation to avoid rushing
- Avoid stressful circumstances (rush hour, night driving, heavy traffic)
- Be aware that automated external defibrillators are available on aircraft carrying ≥30 passengers 1
Why Oxygen Concentrators Don't Solve the Problem
Even if oxygen were available, it would not adequately address the risks in unstable angina:
- Flow rate limitations: Airlines typically only provide 2-4 L/min oxygen flow 1, 2, which may be insufficient for a patient with active cardiac ischemia
- Oxygen addresses only one risk: While supplemental oxygen can correct hypoxemia, it does not eliminate the increased cardiac workload, stress, or limited access to emergency cardiac care at 35,000 feet 1
- Regulatory barriers: Patients cannot use their own oxygen equipment and must rely on airline-supplied systems or approved POCs 2
The Bottom Line
Unstable angina is a medical emergency requiring immediate stabilization, not air travel. The patient needs urgent medical evaluation, risk stratification, and likely hospitalization with consideration for revascularization 3. Only after the angina has been stabilized, symptoms controlled, and appropriate treatment implemented should air travel even be considered—and then only with explicit clearance from their cardiologist 1.
Common Pitfall to Avoid
Do not confuse stable angina (which may allow travel with precautions) with unstable angina (which is an absolute contraindication to elective air travel). The term "unstable" indicates ongoing myocardial ischemia that could progress to infarction, making the patient unsuitable for the physiological stresses and limited medical resources of commercial aviation 1, 3.